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- APPLICATION FOR INELLIPUMP PEf mx w <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH S ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.a Box aft 304 Ear"MM AMDW s^r'OOMK CA Mouse <br /> (20s► 4Bt�8440 <br /> NNOAf1iE rEI1NIT f BEAN FfIOM GATE It011 0 ; <br /> APPLICATION W HERE BY MADE TO THE SAN JOAOM COUNTY FOR A PBrNR TO coPISTRu ND"INSTALL THE WO'qK T h) <br /> 'IOC COUNTY DEVELOPMENT CHAPTER 9-1115.3 AND THE sTANOAW#OF SAN JOAOUSI COUIRy PUKX TH BE VIC .E APPLICATION n MADE DWou.COMPLIANCE yyRM BAN <br /> JOB ADDRESSpR APN/ 950 A�IAI, IRM HEALTH BERVICEe,ENVMIpp�yEET�K HEALTH DIVIU <br /> cmr S'IO(K'tOPI SITE (XODE: 1152 ' I <br /> �p �p ��p� PARCEL SRE/APNaP <br /> OWNIM NAME a7►Jeeil—FR RANO ES (�IM �) ADORE" 12609 ES �, IDDM <br /> DItII7.IiBs, ; 17301t)RI= C-673504 ,x, 1-800-201 .1 <br /> .us coNrTaOTORL_ <br /> ADM" LICE PHONE a <br /> ❑ ►Ew wELL ❑ REPLACEMENT wEu ❑ MOWOMM WELL/_ly ❑ OTHER <br /> ❑ mTALLATION ❑ wuL SYSTEM RwAM ❑ CnowcoNNECT IIEPAM ❑ VAPOR EXTRACTION WELL <br /> 13 N.tv❑Rg.N H.P. DEPTH PUMP SET FT. <br /> R aLRLAPI FIRST WATER LEVEL O <br /> ❑ OUT-OFSNIVICE WELL ❑ oEOPHYSICAL WELL I ❑ Box sown <br /> QasTRucTIDN 3 iN fI'1TRI`m walS s <br /> 13NRDI*TINAL (3 OPEN BOTTOM A <br /> DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO D <br /> 11DOMEWWWRSVATE QORAVEL PACICNQE`L_ TYPE OF CASING/Inimpvc <br /> ❑ � � ❑DRIVEN DIA.OF WELL CAM D <br /> DOTH OF OIIOVf SEAL` a ow�aPECIFICATION : R <br /> 13 NNSSATIONtAS ❑OTHER <br /> GROW SEAL INSTALLED <br /> BBV"� f GROUT SPAM NAME _IN E <br /> ARMPNN:OS►fN <br /> RORN00" EAL oROUT SPUMPED: 1y- ON. CONCRETE PEDESTAL BY DRILLER❑Ya. 13N. a <br /> LOCKMIo CH�BOXWOVE PIPE a <br /> PIIOFO/O Cn 0 IUCTM&OMUNG MSTHOO. MUD ROTARY AM ROTARY AUolR1 _CARIE OTHER <br /> I HEREBY CBT W THAT I HAVE PIIRPARED TNN APPLICATION ANO TNAT THE WORK WILL BE DONE IN ACCORDANCE WTH SAN OF THE SAN JOJOAatm COUNTY ORDINANCES.STATE LAWS.AND 1NItJfs ARID <br /> INNIINATIONS AOINN COUNTY. HOME OWNER OR LICBISED AOENT'I MONATURE CER WW*THE FOLLOWM:I CWTTWY THAT O THE P8940V DANCE OF THE WORK Pon tMBCH <br /> THIS POW N MGM,i SHALL NOT BON SUBJECT TO tlVCRBSAAWS COIIINWWMN LAWS OF CALIFOANIA.' CONTRACTOR'S IINISN OR�WI NATURE Co. <br /> THE '1 CBTTN'Y THA THE ANCE OF THE WORK FOR W►6Cil TMS PERMIT N ISSUED,1 SHALL EMPLOY PNISONS SUBJECT TO WOOMMA"OOMPEPSATION LAN*OF <br /> A� CANr01NBA ANT CALLI P MCI FOR ALL R[OUNIND WWWTmn AT OM I004942S. COMPLETE DRAWMIa AT LOWER AREA PROVIDED. <br />(�' �0 +x •=J TIu. PRESMW Date 7-10-% <br />�vzl- <br /> PLOT PLAN prow to Sola NAMES OF STREETS OR ROADS NEAREST TO OR BOUIOMIS THE PROPERTY. t. LOCATION OF HOUSE SEWAGE DNPOSAL SYSTEM on pROPOSEII <br /> OUTLINE OF THE PROPERTY,GMNO DWINISIONS AND NOM DIRECTION. EXPANSION OF SEWAGE ONPOSAL <br /> sverEMs. <br /> 7. XW OUlnRM AND LOCATION OF ALL EXWTINS AND PROPOSED I. LOCATION OF WELI.s wnim RADIUS OF ONE HUNDRED FIFTY Fr.- <br /> 000 0 AREAE SUCH AS yATWk DIMMMYS,AND WALK& ON THE PROPERTY OR ADJDBIBIB FROPBITY. <br /> d............. I ° . <br /> .. 3 I .. <br /> .... <br /> 6 1� <br /> e ti <br /> 'N <br /> i <br /> PAYMENT`....:......:..... .. . <br /> ........ J U L 11g .. ............... <br /> ... . ..... SAN JOAQUIN uGUN.Ju.....'............. <br /> PUBLIC HEALTHSERV!C•ES <br /> OMtAfITMINT LIRE way <br /> 1A6c+ Mpw.tion A..ged flT D.t. �/ Am <br /> Gnat hopm" By D" "Irww"on BY Osep <br /> 1 a <br /> Cowww": <br /> AOCBLRTnw wav: A" FACT <br /> N COON FR INFO ANOINT 11BMtTTm !CASH 1w0/Ve tlY DATE /UMT/i/hIIS R[oUNT NUMBER _ <br /> . , <br />